What is the treatment for forearm tendonitis?

Treatment of Forearm Tendonitis

Begin with a 3-6 month trial of conservative management consisting of relative rest, eccentric strengthening exercises, NSAIDs, and ice therapy before considering any invasive interventions. 1, 2

First-Line Conservative Treatment

Relative Rest and Activity Modification

• Allow patients to continue activities that do not worsen pain, but avoid complete immobilization to prevent muscle atrophy and deconditioning 1
• Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 1
• For athletes and manual laborers, modify technique to minimize repetitive stresses on the forearm extensors 1

Eccentric Strengthening Exercises

• Eccentric exercise is the cornerstone of treatment and has proven beneficial in multiple tendinopathies, likely helping forearm tendonitis as well 1, 2
• These exercises can reverse degenerative changes in the tendon 2
• Stretching exercises are widely accepted and generally thought to be helpful 1

Cryotherapy

• Apply ice through a wet towel for 10-minute periods for short-term pain relief 1
• Ice reduces tissue metabolism, slows release of blood and proteins from surrounding vasculature, and blunts the inflammatory response in acute cases 1

NSAIDs

• Topical NSAIDs are preferable to oral NSAIDs because they reduce tendon pain while eliminating the increased risk of gastrointestinal hemorrhage 1
• Oral NSAIDs effectively relieve pain and may offer additional benefit in acute inflammatory tendonitis 1
• For oral naproxen specifically: start with 500 mg followed by 500 mg every 12 hours or 250 mg every 6-8 hours for acute tendonitis, with initial daily dose not exceeding 1250 mg 3
• Important caveat: NSAIDs provide only short-term pain relief but do not affect long-term outcomes or alter the natural history of tendinopathy 4, 5

Orthotics and Braces

• Tennis elbow bands (counterforce braces) can reinforce, unload, and protect tendons during activity 1, 2
• These are safe, widely used adjuncts despite limited data supporting definitive conclusions about effectiveness 1

Second-Line Treatment Options

Corticosteroid Injections

• Use with extreme caution and only for acute phase pain relief 1, 2
• May be more effective than oral NSAIDs for short-term pain relief but do not alter long-term outcomes 1
• Critical pitfall: Never inject directly into the tendon substance as this inhibits healing, reduces tensile strength, and predisposes to spontaneous rupture 1
• Peritendinous injections should also be used cautiously as their effects are unknown 1

Other Modalities

• Therapeutic ultrasonography may decrease pain and increase collagen synthesis, but evidence for consistent benefit is weak 1
• Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research to clarify optimal treatment strategies 1
• Iontophoresis and phonophoresis are widely used but lack well-designed RCTs to permit reliable recommendations 1

Expected Outcomes

• Approximately 80% of patients with overuse tendinopathies recover completely within 3-6 months with appropriate conservative treatment 2, 6, 7

Surgical Management

• Surgery is warranted only if pain persists despite 3-6 months of well-managed conservative treatment 1, 2
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2

Critical Pitfalls to Avoid

• Do not use complete immobilization for prolonged periods 1
• Do not inject corticosteroids into the tendon substance 1
• Do not proceed to surgery without an adequate 3-6 month trial of conservative treatment 2
• Do not rely on NSAIDs alone for long-term management—they provide only symptomatic relief 4, 5
• Recognize that most chronic tendinopathies involve degenerative changes rather than inflammation, making anti-inflammatory strategies often inappropriate 4, 8